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Biomedical subjects

G Harper

Publications and source records attributed to G Harper.

At least 55 records · Page 3Linked to original sources
PubMed1994

The changes in blood pressure after acute stroke: abolishing the 'white coat effect' with 24-h ambulatory monitoring.

OBJECTIVES: To assess the changes in 24-h and casual blood pressure (BP) levels following hospitalization for acute stroke. DESIGN: Prospective study of patients admitted with acute hemispheric stroke and hospitalized controls using casual and 24-h BP monitoring. SETTING: Medical wards in a large teaching hospital. SUBJECTS: Thirty-three patients (median age 77 years, 17 male) and 21 control subjects admitted non-acutely. INTERVENTIONS: All subjects underwent 24-h BP monitoring within 24 h of stroke onset (patients) or admission (controls) and again at 1 week. Casual BPs were recorded over the same period. MAIN OUTCOME MEASURES: The change in BP over the first week in each group. Eleven stroke subjects had 24-h BP monitoring repeated at 6 months. RESULTS: In the stroke group, 24-h systolic BP (SBP) fell by 7 mmHg (95% CI, 0 to 14 mmHg; P < 0.05) and diastolic BP (DBP) by 3 mmHg (95% CI, 0 to 6 mmHg; P < 0.02) over the first week. Mean 24-h BP levels in the control group did not change during this period. However, casual BP recordings fell in both stroke (18/12 mmHg) and control (19/9 mmHg) groups. Stroke subjects followed to 6 months showed no further change in 24-h BP (day 7: 137 +/- 17/79 +/- 13 mmHg; month 6: 138 +/- 16/78 +/- 11 mmHg). CONCLUSIONS: Although there was a large fall in causal BPs seen in both groups there was only a small, but a significant fall in mean 24-h BP over the first week following hemispheric stroke that was not seen in control subjects. Although the 'white coat effect' and admission to hospital play an important part in the high casual BP observed in the days following acute stroke they are unlikely to be the sole factors.

Acute Disease↗
PubMed1994

Factors affecting changes in blood pressure after acute stroke.

BACKGROUND AND PURPOSE: We sought to establish the pattern of blood pressure (BP) change after hospitalization for acute hemispheric stroke. METHODS: In 292 patients from the Leicester teaching hospitals with acute hemispheric stroke within the previous 24 hours (139 men; median age, 75 years [range, 42 to 98 years]), we prospectively studied BP changes between admission, 24 hours, 1 week, and 4 to 6 weeks. Changes were assessed in relation to the main stroke risk factors, stroke type and severity, and antihypertensive drug treatment. All subjects were followed up for 1 week, with 117 subjects followed up for 4 to 6 weeks. Changes were assessed by repeated-measures ANOVA, and Student's t tests were used to compare group pairs. RESULTS: Systolic and diastolic BP fell by 12 mm Hg (95% confidence interval [CI], 8 to 15 mm Hg) and 7 mm Hg (95% CI, 5 to 9 mm Hg), respectively, in the first 24 hours and 22 mm Hg (95% CI, 18 to 25 mm Hg) and 12 mm Hg (95% CI, 10 to 14 mm Hg), respectively, during the first week (all changes significant at P < .01) but no further thereafter. In those patients receiving no antihypertensive medication before or after stroke, the pattern of change was similar to that of the whole group. Previously diagnosed hypertensive subjects (n = 106) had higher initial BP values than did normotensive subjects, although by 1 week the levels were not significantly different. Patients with cerebral hemorrhage confirmed by computed tomography (n = 20) had higher systolic BP, but not diastolic BP, throughout the first week than those with cerebral infarction (n = 89). The severity of stroke, age, and previous stroke history did not appear to alter the BP pattern. Stroke patients who were moderate to heavy alcohol consumers had lower convalescent systolic BP levels than lighter drinkers or abstainers. CONCLUSIONS: We have demonstrated a marked fall in systolic and diastolic BP levels during the first 7 days after acute hemispheric stroke, with little change thereafter. Higher initial systolic BP values were found in patients with cerebral hemorrhage compared with those with cerebral infarct. Moderate to heavy alcohol consumption before stroke was associated with a greater systolic BP decline in the first week after the event compared with stroke patients who were light drinkers or abstainers.

Aged↗
PubMed1994

Continuous infusion bleomycin in AIDS-related Kaposi's sarcoma.

PURPOSE: To determine the toxicity, response, and survival rate of 72-hour continuous infusion bleomycin administered to patients with AIDS-related Kaposi's sarcoma. PATIENTS AND METHODS: Seventeen patients with biopsy-proven and measurable-disease AIDS-related Kaposi's sarcoma were treated with a continuous infusion of bleomycin at a dose of 20 mg/m2/d for 3 days every 3 weeks. All patients were evaluated for toxicity, response, and survival using the National Cancer Institute common toxicity criteria, and both the Eastern Cooperative Oncology Group (ECOG) and AIDS Clinical Trials Group (ACTG) response criteria. Fourteen of 17 patients (82%) enrolled had at least two on-study poor-risk factors by ACTG staging criteria. RESULTS: A total of 59 cycles of therapy were administered. Only one cycle (2%) was complicated by an absolute neutrophil count less than 500, and there were no episodes of febrile neutropenia. Fifty-four percent of cycles were associated with fever during the infusion, and five cycles (8%) were complicated by grade 3 rash. There were no other clinically significant (> or = grade 3) toxicities. There were seven partial remissions (41%) by ECOG criteria (95% confidence interval, 18% to 64%) and 11 partial remissions (65%) by ACTG criteria (95% confidence interval, 42% to 88%). Three of five (60%) previously treated patients had a partial remission with this schedule of bleomycin. The median survival duration was 7 months, with a range of 2.5 to 25 months. CONCLUSION: This continuous infusion schedule of bleomycin is active in patients with advanced-stage AIDS-related Kaposi's sarcoma and has acceptable toxicity. This regimen should be further evaluated in patients with earlier stage Kaposi's sarcoma and as salvage therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Predictors of osteopenia in premenopausal women with anorexia nervosa.

The study retrospectively evaluated risk factors for osteopenia in anorexia nervosa (AN) patients. Sixty-nine outpatient, female anorexia nervosa patients (age range 20-40 years, mean 27.5) at varying stages of recovery, and 31 controls had lumbar spine trabecular bone density assessed with single energy computed tomography (CT) scans. An investigator-based, semistructured interview assessed weight and menstrual histories from age 10. Current exercise and dietary calcium levels were categorized and lifetime durations in categories were estimated for each subject. Bone density was significantly lower in the patient group (mean 120 mg/cm3) than in the controls (mean 148 mg/cm3, P less than 0.001). Bone density correlated significantly with duration of illness, amenorrhea, and weight histories but not with measures of dietary calcium or exercise histories. The most important predictor of bone loss on stepwise multiple regression analysis was duration of AN (23% of variance, P less than 0.001), and duration of an inadequate calcium intake in adolescence explained a further 5% of the variance (P = 0.052). There was no evidence that regular exercise and adequate dietary calcium prevented bone loss related to prolonged periods of low weight and amenorrhea in these subjects.

Adult↗
PubMed1992

Cerebellar manifestations of prostatic carcinoma.

We present two patients known to have prostate cancer who presented with acute cerebellar signs. The neurological deficit of the first patient was due to a paraneoplastic cerebellar manifestation and progressed, despite evidence of response of the primary prostate tumour to hormonal manipulation. The second case, resulting from a solitary cerebellar metastasis, was amenable to surgical intervention and subsequent hormonal manipulation. This latter patient has experienced no recurrent neurological signs after a period of 7 years follow-up. This is the first report of a paraneoplastic cerebellar deficit and, to our knowledge, only the sixth case of parenchymatous cerebellar metastasis of prostatic origin to appear in the literature.

Acute Disease↗
PubMed1990

The effect of infused fat emulsions on reticuloendothelial function in the rabbit.

The effect of the infusion of different fat emulsions (Intralipid and MCT/LCT mixtures) on the reticuloendothelial function of the rabbit has been investigated. Emulsions containing 20% dispersed triglyceride were administered over 6 h to a total of 3 g/kg body weight. The extent of blockade of the reticuloendothelial system was measured using a labelled probe in the form of technetium-99m labelled albumin microspheres. Scintigraphic and blood and organ level determinations demonstrated that all emulsions caused an impairment of reticuloendoethlial function, but this was small.

Journal Article↗
PubMed1990

Learning disabilities: an appraisal of Rorschach response patterns.

Recent developments with the Rorschach invite research concerning cognitive and coping styles of learning disabled students. This study, based on an N of 25 (12 learning disabled and 13 controls), was designed to assess group differences in perceptual accuracy, self-concept, and reactivity. Analysis showed that learning disabled students represent a diverse population for which highly individualized understanding is required if appropriate schooling strategies are to be devised. Such students, compared with controls, were more inclined to have lower self-confidence, to be more reactive, to avoid emotionally-laden stimuli, to manifest a higher proportion of responses involving perceptual inaccuracies, and to be less spontaneous and less inclined to take risks. Some curricular implications of the findings are discussed.

Child↗